Surgical resection instrument and accessory



1965 R. BRUMMELKAMP SURGICAL RESECTIONLINSTRUMENT AND ACCESSORY FiledDec. 5, 1961 4 Sheets-Sheet 1 Fifi O O O O INVENTOR. Raindgr Bmnmtl gmBY tbfuw W Mesftrn Feb. 2, 1965 BRUMMELKAMP SURGICAL RESECTIONINSTRUMENT AND ACCESSORY Filed Dec. 5, 1961 4 Sheets-Sheet 2 IN VENTOR.

Rlimlul Brmmmdhmp Feb. 2, 1965 R. BRUMMELKAMP 3,168,096

SURGICAL RESECTION INSTRUMENT AND ACCESSORY Filed Dec. 5, 1961 4Sheets-Sheet 3 INVENTOR.

nu'ndld' 31mm! mp Nashua 4.] Mush-H Juli Feb. 2, 1965 BRUMMELKAMPSURGICAL. RESECTION INSTRUMENT AND ACCESSORY 4 Sheets-Sheet 4 Filed Dec.5, 1961 INVENTOR. RUM Bru lkuur Nahum Muhrn United States Patent Oil-ice3,l68,% Patented Feb. 2, 1965 SURGHCAL RESECTEON INSTRUMENT ANDACtIESSQRY Reindert Brummelkamp, Groenleseweg 1, Winterswijk,Netherlands Filed Dec. 5, 1961, Bar. No. 157,878

Claims priority, application Netherlands Dec. 9, 1960 Claims. (til.128-634) The invention relates to an instrument with accessory which isto be used in the resection for carcinoma recti and for other deviationsof the rectum and the rectosigmoid, caused by disease of the human body.

The more common treatment of carcinoma recti or of the rectosigmoidconsists of a total removal of the entire rectum together with itssphincter or closing muscle. Consequently, the patient is afflicted witha permanent anus preternaturalis, which is considered a greatdisadvantage. in the pertinent literature, the opinion lately prevailsthat less mutilating operations are indicated and that operationssparing the sphincter should be preferred.

When in the resection, i.e., the cutting, the remaining rectal tube isshort, e.g., 46 cm. long, the application of a terminal anastomosis and,hence, the recombination of the remaining rectal tube with theneighboring intestinal part, is extremely difiicult with the aid of theknown surgical equipment, if not entirely impossible. An anastomosis isextremely difficult to accomplish in the narrow and difiicultlyaccesible pelvis, especially in the case of obese patients.

Even though the remaining rectal tube can be reached with the finger,space does not permit the execution of the manipulations required for ananastomosis.

It therefore is an object of the invention to provide a novel instrumentwith an accessory which facilitates the application of a goodanastomosis even in the difiicult instances named above. The newinstrument relies on an inversion of the usually narrower colondescendens or of the sigmoid, respectively, into the usually wider lumenof the rectum. This inversion is fixed by means of a ring made of aplastic having a definite profile, which clamps the inverted parts andis enveloped by an annular tension spring. This spring preferably ismade of a corrosionproof metal.

A device is known which effects a combination of two parts of anintenstine. Thereby, a plastic cap, consisting of two parts, is insertedin each open end of the two intestinal parts to be combined, and theirfree ends are laced, or constricted over the parts of the cap. Then theintestinal walls are pushed against each other, so that a so-calledend-to-end anastomosis is effected. A resection cannot be carried outwith this known device at places which are difiicultly accessible. For aresection with the instrument according to the invention, at leastapproximately 5 cm. of the caudal rectal tube must remain while therectum, up to approximately 5 cm. below the tumor, is sacrificed.

According to the invention, the instrument consists primarily of atubular apparatus and of a number of parts which are movable in thedirection of the axis of the tube and are, in part, disconnectable. Theinstrument is, in part, inserted in the anum while another part remainsoutside. The main tube of the instrument is to be inserted in the anusand is closed by a head which is disconnectably attached to a centralshaft traversing the instrument and is movable back and forth on themain tube. When the head is farthest from the free edge of the maintube, a narrower tube part, provided with air suction openings, emergesfrom said main tube. This narrower tube has a bulge on its outside, sothat when a vacuum is created within this tube part by proper vacuummeans,

the rectal wall enveloping this part of the instrument over and undersaid bulge is laced together, or constricted, and lies against thenarrower tube part. These constrictions can be compressed by the head ofthe instrument and are brought back into approximately their initialposition. Inside the head, a knife is disposed, which, upon moving inthe direction of the bulge of the narrow tube part, the latter, thenserving as a dissecting table, is capable of cutting completely throughthat part of the constricted rectal tube which lies between the cuttingedge of the knife and the frontal surface of said bulge. Thereby theperiphery of the cutting circle of the knife is larger than that of thenarrowest place of the constriction of the rectum over the bulge. Duringand after the cutting, the lacing or constriction remains clamped underthe bulge between its underside and an annular part of the instrument,and after the cutting movement, the head with its knife can bedisconnected from the central shaft of the instrument. To the end ofthis shaft, an accessory then is connected, which is disposed in theopen end of the intestine to be combined with the remaining rectal tube.Simultaneously, an expandable part is present within the main tube andenveloping the narrower tube part which remains entirely within the maintube during the action just described. This expandable part has anannular spring near its free edge, which spring, by a further adjustmentof the main tube, extends to the bulge over the free edge of the maintube and there can expand in such a manner that, when the bulge and thefree edge of the main tube again are brought toward each other, theannular spring is stripped off the expandable part and carries the wallof the rectum with it in the direction of an upper lacing of theintestinal part to be connected and around a part disposed in thatintestinal part, thus effecting an invagination and an anastomosis.

Albeit no protection is claimed for the operation itself, a summarydescription thereof is deemed necessary to clarify the action of thenovel instrument and of the accessories. Details of certain surgicalmeasures are omitted as not essential to the description of the actionof the instrument according to the invention.

The patient is prepared, prior to the operation, with laxatives,clysmae, intestinal antiseptics, vitamins, etc., for several days, and,if required, receives blood transfusions. The patient is given narcosisand is placed on the operating table with legs spread in the positionaccording to Trendelenburg. A catheter is inserted in his bladder, and amedianal cut is administered in the lower abdomen, if necessary, up tothe navel. After opening of the abdominal cavity, the liver and theregional lymph glands are inspected and the extent of the tumordetermined. When it has been established that a resection is feasible,the cut of the peritoneum parietale is carried out at the root of themesosigmoid, and the isolation of the two ureters up to the bladder. Thetumor then is detached from its environment, and the haemorrhoidalessuperior is cut at the root. Then, the colon descendens or the oral loopof the sigmoid, respectively, is out between clamps, the distal stump iscovered with an iodine-saturated gauze, and a plastic ring is tied intothe distal stump. After this cutting, the caudal intestinal part issecured with a circular clamp, and the diseased tissue is detached. Therectal part below the tumor is cleaned at a length of approximately 5cm. and freed from fat and fibers, which is required for the success ofthe ensuing invagination and for a good anastomosis.

After this preparation, the instrument according to the invention isintroduced in the anus. The instrument and its accessory, as well as itsuse and function, now will be explained further with reference to theaccompanying drawings, which represent a preferred embodiment of theinvention. However, it should be understood that these are given merelyby way of explanation, not of limitation, and that numerous changes maybe made in the details Without departing from the spirit and the scopeof the invention as hereinafter claimed.

In the drawings,

FIG. 1 is an elevation of the instrument according to the invention,whose front (upper) end has partially been inserted in the anus, whilethe instrument is in closed position.

FIG. 2 to FIG. 11, inclusive, show schematically different positions ofthe instrument during its operation, whereby solely the upper part ofthe instrument has been shown in an enlarged scale and only the cutthrough the left half has been drawn completely.

FIG. 12 shows the upper part of the instrument, almost in its naturalsize.

FIG. 13 shows the lower part of the instrument, also almost in naturalsize.

FIG. 14 shows the accessory.

FIG. 15 shows a cut through a so-called presenting rod.

Referring now to these drawings:

The main tube 1 is entered, through the stretched anus, in the rectumuntil head 2, with its leading edge,

reaches the vicinity of the tumor, whereby a cone 7,

described below, may enter the tumor to a slight extent. The instrumentthen is advanced with head 2 in the position shown in FIG. 1, and thecareful pushing movements in the still closed intestine can be followedthrough the opened abdominal cavity. The main tube preferably iscalibrated, as indicated in FIG. 1, so that the distance of the tumor tothe rima dentata ani can be read, thus determining whether a resectioncan be carried out. The actions described above and those to follow areaccomplished partly by the surgeon and partly by an assistant operatingthe instrument according to the invention.

The port-ion or" the instrument remaining outside the anus is providedwith serving rings 3 and 4 which serve to adjust head 2 relative to tube1 and with a rotatable handle 5. The different reference numerals aregiven only in a part of the figures.

As is shown in the drawings, head 2 rests against the free edge 6 ofmain tube 1, when the instrument is in closed position. For reasonsdiscussed below, head 2 preferably is provided with an obtuse part towhich a bulge 7 connects which is principally conical in two oppositedirections. When the instrument is operated, head 2 can be adjusted inaxial direction so that a notch or groove forms between the lower sideof bulge 7 and the free edge of main tube 1. With this adjustment, anarrower tube part 8 protrudes beyond the free edge 6. Tube part 8 isprovided with air suction openings 8a. When air is sucked out of tubepart 8 by means of a hose connected at 9, the rectal wall 10 comes torest at 12, with lacingor constriction, against tube ,part 8. The mannerin which the movement of the various parts of the instrument isattained, will be discussed below in connection with FIGS. 12 and 13. Itis not of major importance with regard to the salient features of theinvention, nor is the manner in which the various parts of theinstrument are connected and in which they can be adjusted relative toeach other.

Supposing now that serving ring 3 has been turned to the left, therebyeffecting a relative adjustment of head 2' and of main tube 1. Uponfurther turning of ring 3 to the left, a bulge 11 disposed on the tubepart 8, emerges above the free edge 6 of main tube 1. Below this bulge,the narrower tube part 8 also is provided with air suction openings 8a.In practice,'when the constriction 12 has formed, a string is tiedaround the anum, constricted by the air suction, so that the rectum issecurely held in the constriction. tion 13 above the free edge 6 hasformed, the rectal wall 10, by means of the suction air, also is suckedagainst When the constrica short distance from each other, and oneabove. the other, are formed in the rectum. By turning the serving ring4-, head 2 now can be adjusted relative to: the free edge 6, so that thehead approximately returns to its initial position. The inversion in therectal constriction 13 thereby is squeezed between the underside ofbulge 11 and a ring 16 disposed thereunder. This is feasible because thebulge 11 is movable in axial direction to the ring 16 disposed below it.When head 2 emerges, a spring 40 assures that bulge 11 and theunderlying ring 16, separated from each other thereby, are at.a certaindistance from each other. Upon the closing motion of head 2, the bulge11, against the spring action, is pressed :in the direction of ring 16while clamping the inverted rectal wall. The co-action between ring 16,spring 40 and bulge 11 is shown in FIG. 12.

After the first constriction 12 has formed, forceps 12a are clampedaround the rectum, surrounding the predominantly du'al-conical bulge 7,within the abdominal cavity. The jaws of these forceps are semi-circularand have a cross-section approximately the shape of a In this manner,the forceps tightly' grip the dual-conical bulge 7. The forceps are heldtight until an ensuing manipulation of the instrument has taken place.The latter leads tothe cutting of the rectum. For that purpose, a knifeor scalpel, 14, is disposed within head 2, especially within its bulge7. In the embodiment shown, this scalpel 14 not only is adjustable inits axial direction, but also rotatably around the shaft. By turninghandle 5 to the left, the cutting edge 15 of the turning knife 14emerges from below bulge 7 of head 2, whereby, hence, the knife adjustsin axial direction relative to bulge 11. The upper part 1117 of bulge11, facing knife edge 15 and now serving as dissecting table, preferablyis madeof a rather soft material. Upon cutting the constriction of therectal wall lying on the dissecting table, the part of the rectum heldin position by the anum tied with a string to the narrow tube part 8remains within the circular path of the'knife. When the cutting isterminated, the rectal strip-thus obtained can be removed and subjectedto histological examination. The cutting movement hence is such that theknife follows the direction of the passing rectum and cuts off theloop-like constriction within the rectum.

As will be explained more fully in the discussion of FIGS. 12 and 13,head 2 is fastened to shaft 18 by means of screw thread 17. By means ofthe screw thread 19, the knife 14 is rotatable within a drill hole inthe head. The knife is carried along when shaft 18 turns because pins 20engage a slit 21 in a part of the knife provided with screw threads. Thepitch of threads 17 and 19 is different from each other. When shaft 18is turned, the knife reaches the outside faster than head 2 detachs fromshaft 18. For that purpose, the pitch of thread 19 is larger than thatof thread 17. When the cutting motion is finished, due to turning ofshaft 18, head 2 and the knife 14 consequently are detached from shaft18 simultaneously. The thus detached part of the instrument still isheld by the forceps 12a and now is removed together with the diseasedintestinal part as a whole. The lumen of this intestinal part is sealedhermetically, and infection of the field of operation with detritus orwith infected material from the tumor is impossible.

Meanwhile, main tube 1 still remains in the anus while the free edge ofthe cut rectum still is clamped in the instrument. It now is intended tocarry out an anastomosis between the rectal stump remaining in the smallpelvis and the proximate intestinal part. For that purpose, theaccessory is fastened in the proximate intestinal part This accessoryconsists of a plastic ring 22 which widens upward substantiallyconically. This ring-has a groove 220 on its outside, wherein the end ofthe proximate intestinal part is tied. Plastic ring 22 has a screwvthread 25a holding a substantially tube-shaped part 23 which has anexternal screw thread 25, both threads 25 and 25a being lefthanded, part23 also has an internal screw thread 24 corresponding to the thread 17on shaft 18. This enables screwing the tubular part 23 onto shaft 18,the end of which is in the pelvis. For that purpose, the proximateintestinal part 26 (see FIG. 8) with plastic ring 22 and the tubularpart 23 present therein are taken up by the surgeon with a piece ofsterile gauze and moved in the direction of shaft 18. By turning thehandle 5 to the right, screw thread 17 is screwed into thread 24 of part23, whereby constriction 27 approaches constriction 13 of the rectalwall.

This movement is continued until the surgeon finds that the accessorytends to turn with the assembly. As will be described more fully below,the tubular part 23 can be removed from the plastic ring 22 by turninghandle 5 to the right because, when the accessory is held in place, thetubular part 23 turns out of ring 22, since the screw threads 25 on theoutside of part 23 and 25a on the inside of ring 22 are left-handed.Hence, upon turning the shaft to the right, the ring detaches from thetubular part. However, before this detachment takes place, ananastomosis must first be accomplished.

When the accessory is connected to central shaft 18 in the mannerdescribed above, the constriction 27 of the proximate intestinal part 26is at a certain distance from the constriction of the rectal wall (cf.FIG. 6). FIGS. 2 to 5 show the situations described above. By furtherturning handle 5, main tube 1 is returned in such a manner that theexpandable part 23 protrudes beyond the free edge 6 of the main tube. Inthat situation, an annular spring 29 becomes visible. This spring issituated in the vicinity of the free edge of a plurality of lips 30,disposed circularly next to each other. These lips, at the end not shownin the drawing, are linked flexibly in such a manner that the endsaround which annular spring 29 rests, give way outwardly so that thediameter of these lips is enlarged. This manipulation of the instrumentis carried out by turning the serving ring 4 to the left. The centralshaft 18 thereby is pulled in together with the accessory. Thereby, theunderside of plastic ring 22 now gets into the space enclosed by thefree ends of lips 30. The annular spring 29 thereby is expanded, and itsdiameter becomes larger than the inner diameter of main tube 1. If, byturning the serving ring 3 to the right, main tube 1 is adjusted toward,and in the direction of, plastic ring 22, the free edge 6 of main tubeIt pushes against the underside of annular spring 29. The latter then ispressed away from the lips 3t) and inverts in the constriction at 27.Consequently, the outer wall of rectum 10 is carried along with the ringand comes to rest against the outer wall of the proximate intestinalpart in the constriction 27. In order to accomplish a good anastomosis,it is of particular importance to press the outer walls of these twoparts, i.e., of the intestinal part and of the rectum. The requiredsqueeze is provided by the spring 29. At the borderline of death andlife, these two parts later grow together, and a necrosis of theintestinal walls forms. It has been found that after approximately twomonths the connection between these two intestinal parts can berecognized only by the mucous membrane relief without a trace ofstenosis. The annular spring 29 preferably should be of acorrosion-proof metal.

An anus praster, temporarily disposed in the colon transversum for therelief of the anastomosis, is closed after six weeks. After thesituation shown in FIG. 9 has formed, the accessory with the tubularpart 23 must be removed from the body. For that purpose, as shown inFIG. 10, main tube 1 first is brought into a larger distance fromplastic ring 22 by turning serving ring 3 to the left. Then, the frontof the instrument can be opened above the free edge 6 of main tube 1 toa maximum. If serving ring 4 first is turned to the right, the centralshaft 18 is brought forward as far as possible, and plastic ring 22, onwhich the anastomosis is fixed by means of the annular spring 29 insidethe intestine, emerges from the front end of the instrument. This phasealso is shown in FIG. 10. By then turning handle 5 to the right, wherebythe anastomosis is held with gauze in the hand, plastic ring 22, withits left-handed thread, is disengaged from the tubular part 23 in themanner described above. Part 23 remains, due to its right-handed thread,on the central shaft 18. The instrument then is removed, with thetubular part and the central shaft, from the anus. In the intestine,solely plastic ring 22 and the spring which presses at the anastomosisfrom inside, remain. The ring which has a relief passage (not shown inthe drawing) remains in the body for some time and later is removedtherefrom. When the intestinal parts have entirely grown together, theplastic ring detaches itself from the inside of the intestine.

In order to facilitate the removal of plastic ring 22, it is recommendedto install a string 31 at its upper rim in openings 53 provided for thepurpose. This thread also is fastened to the upper end of tubular part23 by means of the apertures 52a in studs 52. This string must be muchlonger than the direct distance between the two fastening points. When,upon the detachment, in the situation shown in FIG. 11, the tubular part23 is pulled out of the central opening of plastic ring 22, the string,remaining tied to the plastic ring, also is pulled out of the anus. Withthe aid of this string, it can be established later on whether or notthe ring has detached itself from the intestinal walls. This can beascertained after approximately 7 to 8 days by gently pulling thestring. The term, string is used herein in preference to thread which isa more common term to distinguish from the screw threads frequentlyappearing in this disclosure.

Now that the different phases of manipulation of the instrument and itsfunctions and those of its subparts have been described, it will beexplained with reference to FIGS. 12 and 13, how a preferred embodimentof the instrument according to the invention may be assembled. FIG. 1shows the instrument consisting of a main tube which carriescalibrations. Bulge 7 of head 2 rests on free edge 6 when the instrumentis in closed position. Further illustrated are the serving rings 3 and4, handle 5 and a perforated sleeve 32, surrounding main tube 1. Sleeve32 serves to ascertain and to fix the positions shown in FIGS. 1 to 11,inclusive. For that purpose, a holder 44- is disposed in a part withinsleeve 32 for an arresting ball 43 which is under spring action. Thisholder engages in the perforations of sleeve 32 when a definite positionhas been attained. The different positions which are attained by turningserving ring 3 are fixed by an arresting ball which cooperates with theapertures in the upper part of sleeve 32 as will be described below indetail. Those positions attained by turning serving ring 4 are arrestedby a second ball which cooperates with the apertures in the lower halfof sleeve 32.

FIGS. 12 and 13 illustrate the upper part and the lower part,respectively, of the instrument which together form the totalinstrument.

At the start of the use of the instrument, head 2 is screwed ontocentral shaft 18 which is provided with threads 17. FIG. 12 shows theinstrument according to the position in FIG. 3. In that position, thecentral shaf 18 is screwed up, and the narrower tube 8, provided withair suction openings 30, is visible. At some distance from the bulge 7of the head 2, which is conical in two directions, a bulge 11 is presenton narrower tube 8, which consists of a soft material 11a at the sidefacing the head 2, since this serves as a dissecting table. In thismanner, the constriction 12 forms, whereas the constriction 13 formsbelow bulge 11. In the head, knife or scalpel 14, having a cutting edge15, is visible. The knife is provided, at its upper side, with aright-handed screw thread 19 whose pitch is higher than that of screwthread 17 left.

.Withinthe head or at the'end of shaft 18, respectively. In the knifehead, slits21 are present into which pins adjustment of head 2 relativeto main tube 1 without turning shaft 18 is accomplished by actuatingserving ring 3. The latter'is rotatable about main tube 1, but cannotbe'adjusted in the axial direction of the latter. When serving ring 3 isturned, the screw socket 34 having internal threads is adjusted by wayof screw socket 35. Socket 35 is rigidly fastened to the internal tube35. The turning of serving ring 3, hence, effects an upward or downwardadjustment of screw socket 34. With this adjustment, a seat 37 for anarresting ball 38 is adjusted which then becomes visible in one oftheapertures 39 of sleeve 32.

After edge 6 of main tube 1 has been further removed from head 2, thenarrower tube part 8 comes into sight, also bulge 11,- above and belowwhich theconstrictions 12 and 13, respectively, are present. Under thepart wherein apertures 33 are disposed, a spring ll is located whichprovides, in the situation depicted, for a certain distance betweenbulge 11 from upper edge 6 or from the upper surface 41 of the ring 16covering it, respectively. A part not shown also can effect that bulge11 can glide along hollow shaft 18 out is held at a definite maximumdistance from ring 16. When head 2 is brought into closed position, thisis accomplished against the action of the spring 40 in such a mannerthat the lower edge of bulge 11 gets close to the frontal surface 41 ofring 16. 'Head 2 is carried to free edge 6 or its upper surface 41,respectively, by turning serving ring 4 to the This ring is fastened toascrew socket 42 having internal threads and also having, on its outside,a seat or support for a ball 43. Ball 43 is actuated by spring 43a andis visible through aperture 44 of sleeve 32. When serving ring 4 isturned to the left, socket 42 is carried along with screw socket 45, thelatter being rigidly connected to inner'tube 36. This adjustment has theeffect that central shaft 18 is pulled downward without rotation sincesocket 42 is freely rotatable around a clamping sleeve 46, clamped onshaft 18 and rigidly connected to ring 4. Central shaft 18 is hollow,and air can be sucked out of the same at 9. Air can enter the shaft at33 and 47. It is obvious that in the manner described the differentpositions of the instrument can be attained.

The perforated sleeve 32 is rigidly fastened to the inner tube 36. Thelatter is provided with a slit 48 wherein a pin 49 of main tube 1 movesup and down in axial direction. This pin 49 prevents turning butfacilitates adjustment of tubes 1 and 36 relative to each other.

Main tube 1, according to the position shown, e.g., in FIG. 7, can bebrought back further with respect to the frontal surface 4-1 of ring 16.in that position, the ends of lips 39 extend beyond edge e and annularspring 29. Lips 30 are substantially loose and are connected by means ofa collar 50a to a ring-shaped part Sflb at 50. a For easy cleaning ofthe apparatus, the lips together with the collar can be removed from thering. By moving these parts of the instrument in the direction of thering 16, the ends of the lips spread out. This expands spring 29. Thisspring, as has been stated above, can be stripped off by. the lips.Spreading of the lips can be effected by the lower edge of plastic ring22 when the latter is fastened to the central shaft, together with theother parts of this accessory, as also has been discussed above.

The accessory is shown in FIG. 6, and, on a larger scale, in FIG. 14.The tubular part 23 has an internal screw thread to be able to cooperatewith the end of central shaft 18. Tubular part 23 also has a left-handedthread 25 on its outside onto which the plastic ring 22 is screwed. Thestrings 31 are fastened at opening 52a that spring again is to be setaround the lips.

,eter of col-1e54, hence, is to correspond to the diameter to the;tubular part 52, and at 53 to the plastic ring and are sufficiently longto extend outside the anus when the tubularpart is'rernoved therefrom.

Finally, in FIG. 15 the" so-called presenting rod is illustrated. Thissimple device has a thread at its end which fits the thread of tubularpart 23. After the latter has been screwed onto the presenting rod, theaccessory can be inserted in the proximate intestinal part, and thepresenting rod then is screwed and removed. Conical portion 54 of thepresenting rod can be usedto stretch annular spring 29, when, aftercleaning of the device,

The diamof the circle which the lips form in unspread position.

I claim as my invention:

1. An instrument tobe inserted at leastin part 'in' the human body, tobe, used in the resection therapy for carcinoma re'ctiand otherdisease-caused abnormalities of the rectum and of the rectosigmoid andfor carrying out ananastomosis between rectum and intestine, which com-1 prises, in combination, a main tube; acentral shaft traversing andprotruding beyond said main tube; a head detachably connected to the topof said central shaft; screw means for connecting and disconnecting saidhead to and from said shaft; a narrow tube concentrically disposedbeyond said central shaft andsaid main tube and protruding 1 beyond thelatter, provided, with air suction openings;

means for'applying a vacuum to, effect air suction; a bulge rigidlyattached to said head, at said heads lower end and resting detachablyupon the upper edge of said main tube; screwmeans to raise said bulgefrom said upperedge of said main tube thereby baring, and providingaccess to,'said narrow tube; said bulge, in raised position, beingcapable of insertion in said rectum therein causing constriction,compression and reversion. of said rectum to approximately its originalposition under the influence of said vacuum in said narrow tube, saidbulge also serving as a dissecting table; a knife disposed in said bulgeand movable through said head, capable of cutting completely throughsaid rectum upon moving in the direction of said head while carrying outa circular v ,motion of a periphery larger than that of the constrictedrectum over. said bulge; screw means for actuating said knife and movingit through said head; means for actuating said head on, and fordetaching saidhead plus knife from said central shaft; a plastic ring,to be inserted in said intestine; a tubular part removably connected tosaid ring; means for attaching said ring plus tubular part to said shaftwhen said head is disconnected therefrom thus bringing said rectum andsaid intestine in intimate contact; means for disconnecting said tubularpart'from said ring after said contact has been made; means for dis- 2.The instrument as defined in claim 1, wherein said head is provided withan obtuse frontal part to which a second bulge is connected, said secondbulge being situated between said obtuse part and'the upper edge of saidmain tube and being substantially conical. in two opposite directions.

3. The instrument as defined in claim 1, "wherein said knife within saidhead is cylindrical and is equipped with screw threads which provide forrotation of said knife in coaction with said head.

4. The instrument as defined in claim 3, wherein the screw threads ofsaid knife have smaller pitch than the screw means by which said head isattached to said central shaft. j

5. The instrument as defined inclaim 1, wherein said means forconnecting said ring plus said tubular part coact with an expandablepart surrounding said narrower tube while the latter remains entirelywithin said main tube without protruding therefrom, said expandable partcomprising a plurality of lips, disposed loosely and circularly aroundsaid narrower tube, a second ring, disposed on the outside of saidnarrower tube, holding said lips at their lower ends, and an annularspring surrounding the upper ends of said lips, said spring beingcapable of being stripped off said lips when said narrower partprotrudes beyond said main tube.

References Cited in the file of this patent UNITED STATES PATENTSCrurnrine Oct. 23, 1906 Miller Oct. 14, 1947 Zack Nov. 2, 1948 GravleeJune 28, 1960 Inokouchi Dec. 27, 1960 FOREIGN PATENTS France Aug. 13,1956

1. AN INSTRUMENT TO BE INSERTED AT LEAST IN PART IN THE HUMAN BODY, TOBE USED IN THE RESECTION THERAPY FOR CARCINOMA RECTI AND OTHERDISEASE-CAUSED ABNORMALITIES THE RECTUM AND OF THE RECTOSIGMOID AND FORCARRING OUT AN ANASTOMOSIS BETWEEN RECTUM AND INSTINE, WHICH COMPRISES,IN COMBINATION, A MAIN TUBE; A CENTRAL SHAFT TRAVERSING AND PROTRUDINGBEYOND SAID MAIN TUBE; A HEAD DETACHABLY CONNECTED TO THE TOP OF SAIDCENTRAL SHAFT; SCREW MEANS FOR CONNECTING AND DISCONNECTING SAID HEAD TOAND FROM SAID SHAFT; A NORROW TUBE CONCENTRICALLY DISPOSED BEYOND SAIDCENTRAL SHAFT AND SAID MAIN TUBE AND PROTRUDING BEYOND THE LATTER,PROVIDED WITH AIR SUCTION OPENINGS; MEANS FOR APPLYING A VACUUM TOEFFECT AIR SUCTION; A BULGE RIGIDLY ATTACHED TO SAID HEAD AT SAIDHEAD''S LOWER END AND RESTING DETACHABLY UPON THE UPPER EDGE OF SAIDMAIN TUBE; SCREW MEANS TO RAISE SAID BULGE FROM SAID UPPER EDGE OF SAIDMAIN TUBE THEREBY BARING, AND PROVIDING ACCESS TO, SAID NARROW TUBE;SAID BULGE, IN RAISED POSITION, BEING CAPABLE OF INSERTION IN SAIDRECTUM THEREIN CAUSING CONSTRICTION, COMPRESSION AND REVERSION OF SAIDRECTUM TO APPROXIMATELY ITS ORIGINAL POSITION UNDER THE INFLUENCE OFSAID VACUUM IN SAID NARROW TUBE, SAID BULGE ALSO SERVING AS DISSEECTINGTABLE; A KNIFE DISPOSED IN SAID BULGE AND MOVABLE THROUGH SAID HEAD,CAPABLE OF CUTTING COMPLETELY THROUGH SAID RECTUM UPON MOVING IN THEDIRECTION OF SAID HEAD WHILE CARRING OUT A CICULAR MOTION OF A PERIPHERYLARGER THAN THAT OF THE CONSTRICTED RECTUM OVER SAID BULGE; SCREW MEANSFOR ACTUATING SAID KNIFE AND MOVING IT THROUGH SAID HEAD; MEANS FORACTUATING SAID HEAD ON, AND FOR DETACHING SAID HEAD PLUS KNIFE FROM SAIDCENTRAL SHAFT; A PLASTIC RING, TO BE INSERTED IN SAID INTESTINE; ATUBULAR PART REMOVABLY CONNECTED TO SAID RING; MEANS FOR ATTACHING SAIDRING PLUS TUBULAR PART TO SAID SHAFT WHEN SAID HEAD IS DISCONNECTEDTHEREFROM THUS BRINGING SAID RECTUM AND SAID INTESTINE IN INTIMATECONTACT; MEANS FOR DISCONNECTING SAID TUBULAR PART FROM SAID RING AFTERCONTACT HAS BEEN MADE; MEANS FOR DISCONNECTING SAID TUBULAR PART FROMSAID SHAFT; AND MEANS FOR REMOVAL OF SAID RING FROM THE HUMAN BODY AFTERSAID CONTACT BETWEEN SAID INTESTINE AND SAID RECTUM HAS BECOMEPERMANENT.